Perspective: The Future of Interventional Cardiology: An Interview With David J. Moliterno, MD, FACC

Cardiology Interventions

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In an interview with Sun Moon Kim, MD, a Fellow in Training (FIT) at the University of Kentucky, David J. Moliterno, MD, FACC, the Jack M. Gill Chair and Professor of Medicine at University of Kentucky, discusses his past experiences and future goals as the newly appointed editor-in-chief for JACC: Cardiovascular Interventions.

Dr. Kim: What was your inspiration to pursue a career in interventional cardiology?

Dr. Moliterno: It started with a strong foundation in invasive cardiology. I was fortunate to be at the University of Texas Southwestern Medical Center (UTSW) under two icons in the field, L. David Hillis, MD, and Richard Lange, MD, FACC. It wasn’t just about doing the procedures correctly, but rather understanding the “what and why” beyond the “how.” This is what inspired me toward the science behind cardiac catheterizations. All too often we are attracted by the results, but there is a huge underpinning from the science and the understanding of what we are doing. Following my training at UTSW, I was also quite fortunate to learn from perhaps the best clinical investigator in the world, Eric Topol, MD. I spent more than a decade with him where I was drawn by the knowledge and leadership he was putting into the field. Being around Eric and the team at the Cleveland Clinic, it was easy to be infected with enthusiasm. Under Eric’s leadership and guidance, I was able to learn and apply organizational skills toward multinational interventional clinical trials.

What are some of your major career challenges and accomplishments?

It is something I faced throughout my career and still face virtually every day. It has to do with being always happy but never satisfied. One of the challenges of being around great people is that you aspire to be great like they are. If you try to keep up with the best imagers, the best interventionalists, the best teachers, and the best scientists, it is very difficult to be at their level. How can you be the best at everything when you know you really can’t? Then add the aspect of trying to be a great parent, spouse and society member, and at times it’s daunting. This has been a personal challenge, but on the other hand it is also what’s most rewarding – having great relationships, personally and professionally, and being around so many great people.

Where do you see yourself in 10 years?

I think the best thing about being in academic medicine is the ability to influence the future. I am often asked by trainees, why not private practice? I believe private practice is fabulous for affecting today. However, academic medicine empowers you with the ability to influence the future through trainees, young faculty members and organizations such as the ACC. So, where do I see myself heading? That’s an easy answer – trying to nurture, inspire and help the next generation of health care leaders. It is a great joy to look around and see the many chiefs of cardiology, young investigators and authors who have established and matured their careers in the Gill Heart Institute here at the University of Kentucky.

Do you have any advice for fellows who are interested in following in your footsteps?

Apply yourself to do the best you can, and align yourself with successful people wherever you are. In other words, find the best mentor. It may not always be the mentor you first thought of or in the area you were most interested, but if you can find somebody who is successful and enthusiastic about teaching and mentoring, you can learn from their guidance and trajectory. For graduating fellows, especially for those going into academics, figure out how your interest can be synergistic with the local strength of the institution at which you land.

What major changes do you foresee in the field of interventional cardiology?

This may be too vague and far off for people to believe, but it’s the meaningful application of personalized medicine. This is gaining traction in fields such as tumor-marker oncology. Consider most cardiovascular medications: we give a fixed drug type and dose despite the wide range of pharmacologic responses among individuals. There are two ways to change this approach. One is with the collection and management of extremely large data sets where you try to provide optimal care, with a higher degree of outcome probability, by using a massive cohort of patient encounters and distill that down to individual patients. Should they have a higher dose of ACE inhibitor, or should they be shifted to an angiotensin receptor blocker? Should they be on lifelong beta-blockers, or should the medication be transitioned after a few months? These are the answers that our medical guidelines try to address, but we know a substantial portion of our guidelines are still opinion-based and not evidence-based. That’s one end of the spectrum.

The other end parallels our experience with tumor markers in oncology, but this hasn’t been of great value for cardiology. This is probably because of the polygenic and multifactorial nature of cardiovascular disease. In cardiovascular medicine, probably only 10 to 15 percent of our current knowledge of related genetics impacts the total formula of outcome, meaning that the non-genetic aspects we currently understand are at least six to seven times more important than the genetic information we have. I imagine this will evolve to where genetics and better predictive models will help us deliver more individualized care in the future.

What are your visions for JACC: Cardiovascular Interventions as the new editor-in-chief?

I have several key goals, but they are largely to continue the path set by a very great man, Spencer B. King III, MD, MACC. King is a true icon in the field and if I can live up to part of his legacy, I would be satisfied. One of my main goals is to increase and broaden the involvement of others with JACC: Cardiovascular Interventions. My commitment is to make sure there is no bias, even if unintended, and to have the highest possible diversity and inclusivity of authors, reviewers and associate editors. I am hoping to find more input from women, who are less than 10 percent of all interventional cardiologists, and under-represented minorities. In addition, I want to broaden the editorial board to have yet more involvement from around the globe. I’ll be making some announcements and dedicate an Editor’s Page describing some of these goals in the near future.